OBJECTIVES: To document the nature and extent of homelessness among intravenous drug users (IVDUs) and to examine the relationship between housing status and risk behaviors from initial assessment to six-month follow-up in prospective cohort studies in Chicago and New York City (NYC). METHODS: In Chicago, indigenous field workers at three sites recruited IVDUs not in drug treatment (n=888) for structured interviews. In NYC, outreach workers recruited subjects (n=954) from the streets and a hospital. The subjects' social networks and communities were studied. Subjects were grouped into three housing categories: (1) homeless, living in shelters or on the streets; (2) unstable, sharing housing temporarily; and (3) stable, having own apartment or house. Groups were compared on demographics, drug injection behavior, and risk behaviors including use of shooting galleries and sharing and cleaning injection equipment. RESULTS: Twenty three percent of Chicago IVDUs were homeless and 29% in unstable housing at the initial interview. NYC figures were 16% homeless and 46% unstable. Homeless IVDUs were significantly more likely to report engaging in high risk behavior at both time points. IVDUs in unstable housing reported more risk behaviors than those in stable situations. CONCLUSIONS: These findings have serious implications for interventions aimed at reducing risk of HIV infection among IVDUs. They suggest that the majority of IVDUs face homelessness or unstable housing, which leads to higher rates of risky behaviors.
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